TY - JOUR
T1 - Haemorrhagic conversion of infectious myelitis in an immunocompromised patient
AU - Pohlen, Michael Stephen
AU - Sunwei Lin, Jonathan
AU - Wang, Kevin Yuqi
AU - Ghasemi-Rad, Mohammad
AU - Lincoln, Christie M.
N1 - Publisher Copyright:
© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved.
PY - 2017
Y1 - 2017
N2 - A 28-year-old man recently diagnosed with HIV (CD4 19 cells/mm 3, viral load 3.6 million copies/mL, not on highly active antiretroviral therapy on initial diagnosis at outside hospital), disseminated histoplasmosis, shingles and syphilis presented with paraplegia developing over 3 days. Spine MRI demonstrated a longitudinally extensive cord lesion extending from C3 to the tip of the conus. Brain MRI was consistent with meningoencephalitis. Cerebrospinal fluid findings were notable for positive varicella zoster virus (VZV) and cytomegalovirus (CMV) PCRs as well as a Venereal Disease Research Laboratory titre of 1:2. Patient was started on treatment for VZV and CMV meningoencephalitis, neurosyphilis and high-dose steroids for infectious myelitis. Repeat spine MRI demonstrated subacute intramedullary haemorrhage of the cervical cord. He was ultimately discharged to a skilled nursing facility for long-term intravenous antiviral therapy and rehabilitation. After 59 days in the hospital, his neurological exam remained grossly unchanged, with flaccid paraplegia and lack of sensation to fine touch in his lower extremities.
AB - A 28-year-old man recently diagnosed with HIV (CD4 19 cells/mm 3, viral load 3.6 million copies/mL, not on highly active antiretroviral therapy on initial diagnosis at outside hospital), disseminated histoplasmosis, shingles and syphilis presented with paraplegia developing over 3 days. Spine MRI demonstrated a longitudinally extensive cord lesion extending from C3 to the tip of the conus. Brain MRI was consistent with meningoencephalitis. Cerebrospinal fluid findings were notable for positive varicella zoster virus (VZV) and cytomegalovirus (CMV) PCRs as well as a Venereal Disease Research Laboratory titre of 1:2. Patient was started on treatment for VZV and CMV meningoencephalitis, neurosyphilis and high-dose steroids for infectious myelitis. Repeat spine MRI demonstrated subacute intramedullary haemorrhage of the cervical cord. He was ultimately discharged to a skilled nursing facility for long-term intravenous antiviral therapy and rehabilitation. After 59 days in the hospital, his neurological exam remained grossly unchanged, with flaccid paraplegia and lack of sensation to fine touch in his lower extremities.
KW - HIV / AIDS
KW - infection (neurology)
KW - infections
KW - radiology (diagnostics)
UR - http://www.scopus.com/inward/record.url?scp=85037697814&partnerID=8YFLogxK
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U2 - 10.1136/bcr-2017-221866
DO - 10.1136/bcr-2017-221866
M3 - Article
C2 - 29197841
AN - SCOPUS:85037697814
SN - 1757-790X
VL - 2017
JO - BMJ Case Reports
JF - BMJ Case Reports
M1 - 221866
ER -